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Individual
AMANDA RAY HENDERSON
Active
Individual
AMANDA RAY HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
5440
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
MA063252
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/15/2020
Last updated
07/06/2026
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